Ramblings from an ER physician in Singapore.
(This blog is a personal journal. Any views or opinions presented on this website are solely those of the author's and do not necessarily represent those of her organization. No part of this website may be reproduced or quoted without the author's expressed permission, written or otherwise.)

Thursday, February 19, 2004

In continuation with the earlier discussion of Forum Page complaint letters against hospitals:

Case #2: Miss Peh Lay Har's father

"My father's recent death highlights a problem that has been overlooked: Patients should be diagnosed correctly and taken to the appropriate hospital.
He was a victim of subarachnoid haemorrhage -- a serious kind of stroke -- who urgently needed to undergo a CT scan for broken blood vessels.
An ambulance took him to the nearest hospital -- Alexandra -- on Jan 19, where specific treatments and surgical operations were not available.
The doctor who examined my father told me that he was suffering from a minor stroke, when it was a major one. Upon realizing the severity of his condition, the doctor had him transferred to NUH.When the paramedics arrived at my house that fateful day, they said they did not know what caused my father's fainting and headache, so they took him to AH.
The paramedics failed to recognize that the patient had had a stroke and did not act quickly to reduce his blood pressure so that his life would not be endangered.It is a known fact that stroke patients need to be attended to as soon as possible and the first one to two hours are the most crucial. The patient's recovery -- and life-- depend on it.In my father's case, the informal examination at AH took more than 1 1/2 hours before he was transferred to NUH.By the time he was operated on at NUH, 5 hours had elapsed and his condition had deteriorated to the point where the treatment was difficult and dangerous. He did 5 days later."

-- Miss Peh Lay Har ( Feb 7 2004 )

Reply from AH and NUH:

"We refer to the letter above. Our sincere condolences and empathy are with Miss Peh on the loss of her father.
Her father arrived in an ambulance at AH at 9.55pm and was attended to immediately by the Emergency staff and doctors.
He was adequately and properly examined -- a CT scan was also done -- and all appropriate treatment rendered before he was transferred to NUH at 11:30pm.AH has an established and reliable arrangement with NUH to speedily transfer patients who need specialist attention from a neurosurgeon.
We would like to reassure Miss Peh that, in her father's case, this was done quickly, with constant attention paid to stabilizing him. An AH Emergency Medicine doctor also accompanied the patient to NUH.
In stroke cases, due to the carying modes of presentation and evolution, accurate assessment of severity, even with help from CT scans, can be difficult. We could have done better and communicated this more effectively to Miss Peh, as well as the state of her father's condition and the risks involved. We are sorry that we did not update her well enough after the initial diagnosis.Unfortunately, despite stabilizing him, her father succumbed to a re-bleeding in the brain and, upon arrival at NUH, his condition had deteriorated further. The clinicians did the necessary tests and treated him, knowing that the mortality rate in such cases was high.
We are of the opinion that the patient had been speedily transferred to NUH and treatment was administered without any significant delay.We hope that this letter helps to clarify Miss Peh's concerns over the care given to her late father. Once again, we would like to convey our deepest condolences to the family on the loss of a loved one."

I've highlighted the more important bits.
Readers who hail from the medical profession will no doubt spot the flaws in Miss Peh's complaint instantly. And Dr Wee's logical explanation ( transcribed in my entry dated Feb 17 ) addresses these mistakes directly. Even more disturbing is Miss Peh's over-confidence in her statements. It's all black and white to her, and she didn't even attend medical school!
Also note again the discrepancies between her version of events and the doctors' objective interpretation. As Linda has pointed out in her comments, complaints are often subjective and personal, so it wouldn't surprise me in the least if a few of them are embellished to some degree. And when such letters are published in a paper with a circulation of a few million subscribers, the ripple effects are widespread and yes, DANGEROUS. What do you think people will say? The uninformed will no doubt think the doctors were at fault. The fact that THE FORUM printed the complaint should confirm that, right? Our nation's most reputable newpaper knows best, no? Sadly, not anymore.

There was a letter from the son of another stroke sufferer -- a lady who was admitted to NUH in 1996. Yet an additional illustration of the influence The Straits Times Forum Page has. Of course, the editors must be ecstatic at the response. Which paper doesn't want to generate buzz? However, the question is: At what price? If you resort to printing inaccuracies without first doing your job ( ie. checking the facts and making sure the person's comment can be backed up by reliable data ), then sit back and watch the circus unfold, it's pretty obvious who the irresponsible party is here. And if you argue that the burden is on the respective hospitals / doctors to explain themselves, while your role is purely to print "newsworthy" pieces, then it's a deplorable case of "passing the buck".

And here's the "icing on the cake": a day after I emailed and directed the Forum to my blog ( to read the concerns raised by myself and a few other readers ), THIS appeared in today's edition:

"Recently, my girlfriend visited the dentist at a private dental clinic. While cleaning her teeth, the dentist caught up on the office gossip with his nurse and even began crooning songs to her!
While it is all right to seek relief from the stresses of the work day, there are limits to what is appropriate.
Policemen do not chat about the previous night's television shows while taking a statement, surgeons do not discuss politics in the middle of an operation. Likewise, the dentist in question should not be singing or gossiping while working on a patient.
Is this what one would expect from a healthcare professional?"

-- Damian Chue Wye Luen

My response to Damian:

What does your girlfriend -- aka THE PATIENT -- think of all this? Does she share your sentiments or are these purely your own grouses? Oh wait, perhaps she doesn't want to identify herself, for fear of being found out by the dentist in question? Does this mean she intends to continue consulting said dentist? He must be good at his job then. Is this how Singaporeans show their gratitude nowadays?
Yeesh, doctors get flak for not being communicative enough, and now they're being criticized for being happy, chatty and partaking in singing activities in the presence of the clientele. I certainly hope the Singapore Dentist Association isn't going to entertain this nonsense by issuing a formal reply. This is getting way out of hand.